﻿<!DOCTYPE html>
<html lang="en">
<#include "../include/resource-head.ftl"/>
<#assign active='pd'/>
<body>
<#include "../include/common-top.ftl"/>
<div class="main-container" id="main-container">
    <div class="main-container-inner">
    <#include "../include/common-menu.ftl"/>
        <div class="main-content">
            <div class="page-content">
                <div class="col-xs-12">
                    <div class="row-fluid">
                        <div class="widget-box">
                            <div class="widget-header widget-header-blue widget-header-flat">
                                <h4 class="lighter">
                                    <i class="icon-plus"></i>个人档案修改
                                </h4>
                            </div>
                            <div class="widget-body">
                                <div class="widget-main">
                                    <div class="step-content row-fluid position-relative">


                                        <form class="form-horizontal col-md-8" action="/personal/update" method="post">
                                            <#if personal??>
                                                <input type="hidden" name="id" value="${personal.id!}">
                                            </#if>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">姓名</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="name"
                                                           value="${personal.name!}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">生日</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="birthday"
                                                           value="${personal.birthday!}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">身份证号</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="card"
                                                           value="${personal.card!}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">手机号</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="phone"
                                                           value="${personal.phone!}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">民族</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="family"
                                                           value="${personal.family!'汉族'}" placeholder="汉族"/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">性别</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="sex" value="男"
                                                           <#if (personal.sex!'男') == '男' >checked</#if>>男
                                                    <input type="radio" name="sex" value="女"
                                                           <#if (personal.sex!'') == '女' >checked</#if>>女
                                                </div>
                                            </div>


                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">血型</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="blood" value="A"
                                                           <#if (personal.blood!'A') == 'A' >checked</#if>>A
                                                    <input type="radio" name="blood" value="B"
                                                           <#if (personal.blood!'') == 'B' >checked</#if>>B
                                                    <input type="radio" name="blood" value="AB"
                                                           <#if (personal.blood!'') == 'AB' >checked</#if>>AB
                                                    <input type="radio" name="blood" value="O"
                                                           <#if (personal.blood!'') == 'O' >checked</#if>>O
                                                    <input type="radio" name="blood" value="不详"
                                                           <#if (personal.blood!'') == '不详' >checked</#if>>不详
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">RH阴性</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="rh" value="阴性"
                                                           <#if (personal.rh!'阴性') == '阴性' >checked</#if>>阴性
                                                    <input type="radio" name="rh" value="阳性"
                                                           <#if (personal.rh!'') == '阳性' >checked</#if>>阳性
                                                    <input type="radio" name="rh" value="不详"
                                                           <#if (personal.rh!'') == '不详' >checked</#if>>不详
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">职业</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="prefession"
                                                           value="${personal.prefession!}" required/>
                                                </div>
                                            </div>


                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">婚姻状况</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="hy" value="已婚"
                                                           <#if (personal.hy!'已婚') == '已婚' >checked</#if>>已婚
                                                    <input type="radio" name="hy" value="未婚"
                                                           <#if (personal.hy!'') == '未婚' >checked</#if>>未婚
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">药物过敏史</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="gms"
                                                           value="${personal.gms!'无'}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">既往史</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="jws"
                                                           value="${personal.jws!'无'}" required/>
                                                </div>
                                            </div>
                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">遗传病史</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="ycbs"
                                                           value="${personal.ycbs!}" placeholder="没有可不填"/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">住院治疗记录</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="zyjl"
                                                           value="${personal.zyjl!}" placeholder=""/>
                                                </div>
                                            </div>


                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">是否有糖尿病</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="tnb" value="有"
                                                           <#if (personal.yyyy!'有') == '有' >checked</#if>>有
                                                    <input type="radio" name="tnb" value="偶尔"
                                                           <#if (personal.tnb!'') == '没有' >checked</#if>>没有
                                                </div>
                                            </div>



                                            <hr/>
                                            <div class="row-fluid wizard-actions">
                                                <button class="btn btn-info" type="button"
                                                        onclick="javascript:history.go(-1)">返回
                                                </button>
                                                <button class="btn" type="reset">重置</button>
                                                <button class="btn btn-success" type="submit">提交</button>
                                            </div>


                                        </form>
                                        <div class="clearfix"></div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div><!-- /.page-content -->
    </div><!-- /.main-content -->
</div><!-- /.main-container -->
</body>
<#include "../include/resource-script.ftl"/>
</html>

